The Open Setting: Empowering Patients Through Responsibility and Freedom at the Austen Riggs Center

The Austen Riggs Center is more than a psychiatric residential treatment center—it’s a therapeutic community, an open psychiatric setting, and an institute for education and research.

Our mission is to promote resilience and self-direction in people facing complex psychiatric challenges—to help individuals take charge of their own lives.

We believe that psychological suffering is inherently meaningful, best understood within a social and relational context, and that genuine healing comes from exploring—not avoiding—the sources of distress.

At Riggs, treatment is built around interconnected pillars:

As described by John Muller, PhD, in Reflections on the Open Setting, psychotherapy at Riggs is often a kind of “unlearning.” Patients peel back layers of experience to uncover and challenge old patterns of relating to others and themselves. This can be an intense, vulnerable process, but one that opens the door to self-understanding and transformation.

The open setting serves as a protective framework for this deep work, providing structure, community, and the opportunity to exercise responsibility. Meanwhile, the Therapeutic Community Program and Activities Program support skill-building and creativity—encouraging patients to find new modes of expression and meaning through peer engagement, art, learning, and collaboration. Concurrently, family participation throughout treatment can play a crucial role in helping patients take charge of their lives.

In the open setting, relationships—between patients and staff, and among peers—are central. Together, they form the boundaries, safety, and trust that sustain the community.

Unlike most psychiatric facilities, there are no locked doors, no privilege systems, and no forced participation. Instead, boundaries are maintained through mutual negotiation, dialogue, and collaboration rather than coercion.

Patients are free to come and go from the campus, which sits on the main street of Stockbridge, Massachusetts. They may have cars, cell phones, and personal items that are often restricted in traditional settings.

This openness symbolizes a profound commitment: freedom paired with responsibility. Patients are accountable for their own choices, their safety, and ultimately, their treatment.

At Riggs, freedom and responsibility go hand in hand.

For instance, patients recovering from substance use live near real-world temptations such as bars and dispensaries. Rather than being shielded, they’re encouraged to draw on community support to navigate these challenges. Similarly, those with a history of self-harm learn to manage access to potentially dangerous items—developing self-regulation and trust.

Staff and patients rely on each other to create and sustain an environment at Riggs that is safe and supportive of treatment. With this commitment comes the expectation that patients will refrain some certain behaviors that have a negative impact on community life and undermine growth and development. There are only a few firm rules—violence, persistent substance use, or actions that harm others or the treatment environment are not permitted. Beyond that, the open setting relies on trust, dialogue, learning from choices, and accountability.

This model represents what Riggs clinicians sometimes call a “loving refusal”—a refusal to disempower patients by assuming control over their lives. Instead, staff work with patients, not on them, respecting their capacity for self-determination.

Consider Mark, a patient with a history of suicidal ideation and anger. Shortly after arriving at Riggs, his behavior frightened others. Some patients asked staff to remove him from group sessions.

Rather than taking over, staff encouraged open dialogue. With their support, Mark and his peers discussed the tension directly. Mark came to understand that his outbursts stemmed from feeling dismissed—a pattern that had damaged relationships throughout his life.

This process of honest, supported confrontation helped Mark develop empathy, communication skills, and self-awareness—cornerstones of his recovery.

Freedom carries risk. In the open setting, sometimes patients engage in destructive behaviors, from substance use to self-harm. Rather than responding with control, staff strive to create an environment that “listens”—where destructive acts are understood as communications of distress and meaning. Our Director of the Therapeutic Community Donna Elmendorf, PhD; and our Director of Patient Care Margaret Parish, PhD, ABPP, have written about this–if you would like to learn more, you can read their paper Silencing the Messenger: The Social Dynamics of Treatment Resistance.

This model demands courage from everyone involved. Staff must tolerate uncertainty; patients must take ownership of their safety and choices. The result is an environment of deep trust and mutual respect.

Through the Therapeutic Community Program, patients and staff work together to solve problems, make decisions, and confront challenges as equals.

The Open Setting at the Austen Riggs Center represents a rare and revolutionary approach to psychiatric care—one that honors autonomy, fosters accountability, and promotes authentic healing.

By engaging patients as collaborators in their own treatment, Riggs helps them reclaim agency and rebuild a sense of purpose, belonging, and control over their lives.

In a world that too often prioritizes containment over connection, the open setting stands as a powerful model for hope, trust, and recovery.